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Introduction: Squamous cell carcinoma (SCC) is a skin malignancy typically treated with surgical resection. Non-Hodgkin lymphoma (NHL) is a group of lymphoid tissue malignancies treated with various strategies, including chemotherapy and radiotherapy. Case Presentation: A 64-year-old male with prior SCC presented with a new scalp lesion. Examination revealed an elevated, irregular, non-tender lesion with mild yellow discoloration. Imaging showed a scalp lesion, cervical lymphadenopathies, and a well-defined mass. Ultrasonography uncovered lymph node involvement and splenomegaly. Fine needle aspiration, biopsy, and immune stains of the lymph node confirmed NHL. Wide local excision of the scalp lesion, reconstruction, and lymph node biopsies were performed, confirming SCC and NHL. The patient received radiotherapy and chemotherapy. Conclusion: This unique rare case emphasizes the complex interplay of SCC and NHL, necessitating vigilant SCC patient follow-up.

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Skin cancer can be detected through visual screening and skin analysis based on the biopsy and pathological state of the human body. The survival rate of cancer patients is low, and millions of people are diagnosed annually. By determining the different comparative analyses, the skin malignancy classification is evaluated. Using the Isomap with the vision transformer, we analyze the high-dimensional images with dimensionality reduction. Skin cancer can present with severe cases and life-threatening symptoms. Overall performance evaluation and classification tend to improve the accuracy of the high-dimensional skin lesion dataset when completed. In deep learning methodologies, the distinct phases of skin malignancy classification are determined by its accuracy, specificity, F1 recall, and sensitivity while implementing the classification methodology. A nonlinear dimensionality reduction technique called Isomap preserves the data's underlying nonlinear relationships intact. This is essential for the categorization of skin malignancies, as the features that separate malignant from benign skin lesions may not be linearly separable. Isomap decreases the data's complexity while maintaining its essential characteristics, making it simpler to analyze and explain the findings. High-dimensional datasets for skin lesions have been evaluated and classified more effectively when evaluated and classified using Isomap with the vision transformer.

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BACKGROUND: Idiopathic inflammatory myopathy (IIM) is a group of chronic acquired autoimmune diseases. The association between IIM and malignancies has been observed for decades. No meta-analysis has been conducted to summarize the relationship between IIM and melanoma. Herein, we specifically wanted to investigate whether IIM is associated with a higher incidence of melanoma. METHODS: We searched both Chinese and English databases (CNKI, VIP, Wanfang, PubMed, Embase, Web of Science) for studies on IIM related to melanoma published up to October 2023. Two independent authors reviewed all literature to identify studies according to predefined selection criteria. Fixed effects models were applied to pool the risk. Publication bias was also evaluated and sensitivity analysis performed. RESULTS: A total of 1660 articles were initially identified but only four cohort studies met the criteria. Thus, 4239 IIM patients were followed up. The pooled overall risk ratio/hazard ratio was 3.08 (95% confidence interval [CI] 0.79-5.37) and the standardized incidence ratio was 6.30 (95% CI 1.59-11.02). CONCLUSION: The present meta-analysis suggests that IIM patients are at a significantly higher risk of developing melanoma.

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Background: Melanoma is a highly malignant form of skin cancer that exhibits remarkable metabolic adaptability. Melanoma cells exhibit the capacity to adapt to specific conditions of the tumor microenvironment through the utilization of diverse energy sources, thereby facilitating the growth and advancement of the tumor. One of the notable characteristics of metabolic reprogramming is the heightened rate of lipid synthesis. This review was conducted to illustrate how the integration of whole exom and transcriptome sequencing will enhance the detection of the effect of cholesterol metabolism in melanoma. Methods: The Cochrane database, Embase, PubMed, SCOPUS, Google Scholar, Ovid, and other databases were thoroughly searched for works addressing integrated whole exome and transcriptome sequencing in cholesterol metabolism in melanoma. Skin malignancy, melanoma progression, transcriptome sequencing, whole exome sequencing, transcriptome sequencing by RNA sequencing, and integrated transcriptome and whole exome sequencing were the key phrases employed. This article underwent a phased search for pertinent literature using a staged literature search methodology. Each section's relevant papers were identified and summarized independently. The results have been condensed and narratively given in the pertinent sections of this thorough assessment. Results: DNA-based analysis has proven to be ineffective in identifying numerous mutations that have an impact on splicing or gene expression. RNA-Sequencing, when combined with suitable bioinformatics, offers a reliable method for detecting supplementary mutations that aid in the genetic diagnosis of geno-dermatoses. Therefore, clinical RNA-Sequencing expands the scope of molecular diagnostics for rare genodermatoses, and it has the potential to serve as a dependable initial diagnostic method for expanding mutation databases in individuals with inheritable skin conditions. Conclusion: The integration of patient-specific tumor RNA-sequencing and tumor DNA whole-exome sequencing (WES) would potentially enhance mutation detection capabilities compared to relying solely on DNA-WES.

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Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine carcinoma of the skin. It is often found in the sun-exposed skin areas of elderly individuals of Caucasian descent. MCC has a tendency for local recurrence and the potential to invade nearby lymph nodes and spread to distant sites in the body. Here, we present the case of an 83-year-old male with a history of multiple comorbidities, including congestive heart failure, obesity, hypertension, benign prostatic hyperplasia, and sarcoidosis, who presented with a slow-growing, fungating lesion on his left lower leg. Histopathological examination revealed MCC with extensive necrosis and involved resection margins. Additional skin lesions on the left knee were confirmed to be MCC. Follow-up CT scans showed lymphadenopathy and a femoral lesion. The patient was deemed a poor candidate for resection and placed on immunotherapy treatment. The low incidence rate and indistinct clinical manifestations of MCC make a conclusive diagnosis dependent on examining histological features and immunohistochemical markers through a lesioned biopsy or resection. Due to the aggressive nature of MCC and the tendency for asymptomatic and painless lesions to escape notice, it is important to raise awareness about this condition. This will lead to earlier detection and intervention, potentially enhancing patient survival rates.

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BACKGROUND: Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. PATIENTS AND METHODS: A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. RESULTS: A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) = 18.0, p < 0.001) and LND (OR = 21.0, p = 0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. CONCLUSION: SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.

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Background: The possible correlation between melanoma and Parkinson's disease (PD) has been intensively studied. In this work, we aimed to assess the coincidence of skin malignancies and PD at a dermato-oncological university centre in Central-Eastern Europe, Hungary. Methods: From 2004 to 2017, a retrospective analysis of the centre's database was performed based on International Statistical Classification of Diseases-10 codes. Results: Out of the patients who visited the clinic during the study period, 20,658 were treated for malignant skin tumours. Over the 14 years, 205 dermatological patients had PD simultaneously, 111 (54%) of whom had at least one type of skin malignancy: melanoma (n=22), basal cell carcinoma (BCC) (n=82), or squamous cell carcinoma (SCC) (n=36) (in some patients, multiple skin tumours were identified). Compared to the age- and sex-matched control group, patients with PD had a significantly lower risk for basal cell carcinoma (OR, 0.65; 95% CI, 0.47-0.89, p=0.0076) and for all skin tumours (OR, 0.74; 95% CI, 0.56-0.98, p=0.0392) but not for melanoma. Conclusions: We found a decreased risk of all skin tumours and basal cell carcinoma and an unchanged risk of melanoma among patients with PD. However, it should be kept in mind that some large-scale meta-analyses suggest a higher incidence of melanoma after a diagnosis of PD, indicating the importance of skin examination in this vulnerable population.

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@#Squamous cell carcinoma is a form of skin malignancy that involves squamous cells lining the epidermis. It is the second most common form of non-melanoma skin malignancy. We describe a case of squamous cell carcinoma involving the nail bed of an elderly gentleman that was initially diagnosed as a case of fungal infection of the nail bed.

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Dermatofibrosarcoma protuberans (DFSP) is a rare, indolent, cutaneous sarcoma originating in the dermis, and although nearly half of cases occur on the trunk, DFSP of the breast is exceedingly rare, and imaging findings may resemble primary breast neoplasms. In this case report, a previously healthy, middle-aged female patient presented to the clinic with the complaint of abnormal growth in her left breast, which had been gradually increasing in size over the course of four years. Imaging of the left breast demonstrated a large, exophytic, partially intradermal mass with internal vascularity, raising concern for a primary breast neoplasm. Ultrasound-guided core needle biopsy revealed a diagnosis of DFSP. She underwent successful left skin- and nipple-sparing mastectomy with complete resection of the mass with negative margins confirmed on surgical pathology. Recognizing key features of DFSP on conventional breast imaging modalities, such as mammography and ultrasound, can be helpful in differentiating DFSP from primary breast neoplasms, but imaging findings alone may be nonspecific and biopsy is necessary for a definitive diagnosis. On mammography, DFSP typically presents as an exophytic, gently lobulated, non-calcified, and circumscribed mass. On sonographic examination, DFSP appears as a circumscribed, parallel-oriented mass that is hypoechoic relative to the surrounding fat, with intervening echogenic bands, posterior acoustic enhancement, and intralesional hypervascularity visualized on color Doppler. Although DFSP is slow-growing with a low incidence of metastatic disease, it has a high local recurrence rate and aggressive local resection is necessary to minimize the chance of recurrence.

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OPINION STATEMENT: While most skin malignancies are successfully treated with surgical excision, advanced and metastatic skin malignancies still often have poor long-term outcomes despite therapeutic advances. Antibody-drug conjugates (ADCs) serve as a potentially promising novel therapeutic approach to treat advanced skin cancers as they combine antibody-associated antigen specificity with cytotoxic anti-tumor effects, thereby maximizing efficacy and minimizing systemic toxicity. While no ADCs have gained regulatory approval for advanced skin cancers, several promising agents are undergoing preclinical and clinical investigation. In addition to identifying and validating skin cancer antigen targets, the key to maximizing therapeutic success is the careful development of each component of the ADC complex: antibodies, cytotoxic drugs, and linkers. It is the optimization of each of these components that will be integral in overcoming resistance, maximizing safety, and improving long-term clinical outcomes.

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Spindle cell carcinoma (SpCC)/sarcomatoid carcinoma is a biphasic tumor with molecular and histopathological properties of both epithelial and mesenchymal tumors. SpCC usually occurs either in sun-exposed areas like the head, neck, upper extremities, and chest or in the areas of skin with prior radiation exposure or in immuno-suppressed individuals. Cutaneous SpCC is a very rare disease, with only a handful of reported cases so far. SpCC differs from conventional squamous cell carcinoma (SCC) with dermal infiltration of atypical keratinocytes as single cells with hyperchromatic eosinophilic cytoplasm and elongated, pleomorphic nuclei with multiple nucleoli, in contrast to cohesive nests or islands in SCC. The objective of this study is to complete a review of the current literature and present a rare manifestation of malignant SpCC which developed from a localized basal cell carcinoma following excision and radiation therapy (RT) in a 79-year-old female. We plan to elucidate the importance of a timely and accurate diagnosis of this disease in order to maximize treatment options and improve survival outcomes.

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Cutaneous squamous cell carcinoma (CSCC) is the second most common skin malignancy in white-skinned populations. Only a minority of patients (<5%) develop advanced disease, but this is often difficult to treat and characterised by a poor prognosis. Cemiplimab, a fully human IgG4 monoclonal antibody against programmed cell death-1 receptor, is indicated for advanced (i.e. locally advanced or metastatic) CSCC. Although the definition of metastatic CSCC is clear, there is currently no agreed definition of locally advanced CSCC. In recent guidelines, locally advanced CSCC was described as non-metastatic CSCC that is unlikely to be cured with surgery, radiotherapy or combination treatment. A multi-disciplinary advisory group of Italian CSCC experts was convened to develop criteria to assist in identifying appropriate candidates for cemiplimab therapy in advanced CSCC, based on the literature and clinical experience. In locally advanced CSCC, absolute, or mandatory, criteria for the use of cemiplimab are deep invasion, multiple lesions without defined margins, inadequate surgical excision margins and multiple recurrences, whereas relative criteria include large lesions, in critical or functionally significant areas and that are surgically complex. In addition, physicians should consider patient willingness/preferences (an absolute criterion), and their age and health status/comorbidities (relative criteria). It is hoped that these proposed absolute and relative criteria will help guide rational identification of patients who will receive maximum benefit from immunotherapy, while more clinical data accumulate.

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OBJECTIVES: To determine whether groin dissection surgical site infection (SSI) incidence changed with shorter post-operative antibiotic prophylaxis. BACKGROUND: Post-operative prophylaxis changed due to antimicrobial stewardship, from regular oral antibiotics until drain removal, to three intravenous doses. Both groups had a single intravenous dose at induction. METHODS: A prospective database of groin dissections for metastatic skin cancer was retrospectively reviewed for SSI according to Public Health England criteria. Eighty groin dissections in 79 consecutive patients were included: 40 had oral antibiotics until drain removal [mean 26±7 (range 19-36) days] and 39 had three post-operative intravenous doses. RESULTS: Longer prophylaxis was associated with lower SSI incidence [10 (25%) versus 21 (54%), odds ratio (OR) 3.50, 95% confidence interval (CI) 1.34-9.08, p = 0.009], fewer deep infections [5 (13%) versus 16 (41%), OR 4.89, 95% CI 1.57-15.13, p = 0.004], fewer readmissions for infection [5 (13%) versus 15 (38%), OR 4.38, 95% CI 1.40-13.65, p = 0.008], but similar seroma incidence [18 (45%) versus 16 (41%), OR 0.85, 95% CI 0.35-2.07, p = 0.72] and wound dehiscence [7 (18%) versus 5 (13%), OR 0.69, 95% CI 0.20-2.40, p = 0.56]. BMI ≥30 (n = 21) was associated with SSI, occurring in 13 of 21 (62%) (OR 3.859, 95% CI 1.34-11.10, p = 0.01). Median infection onset was 22 days (IQR 12-27) versus 17 (IQR 13-22), (p = 0.53). Multiple organisms were cultured in 21 of 31 (68%) patients with positive microbiological samples. CONCLUSIONS: SSI rates doubled with shorter prophylaxis; deep infections and readmissions for infection tripled. Obesity was independently associated with infection. Seroma and wound dehiscence incidence were unchanged. Infections mainly occurred in the third week after surgery and were polymicrobial.

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Merkel cell carcinoma is rare and aggressive skin cancer, which occurrence is linked to exposure to ultraviolet light and the Merkel-cell polyomavirus. In recent years, significant progress in understanding the mechanism of Merkel cell carcinoma pathogenesis has been observed. This neoplasm often expresses PD-L1, and MCPyV-specific T cells can express PD-1 thus PD-1/PD-L1 checkpoint therapies seem to be remarkably interesting treatment options. Many clinical trials are currently being conducted to confirm their effectiveness and safety for this group of patients. However, only about half of advanced Merkel cell carcinoma patients could achieve remission or disease stabilization through PD-1/PD-L1 checkpoint therapies thus innovative treatments are still needed. In this article, we have presented current and future directions in the development of Merkel cell carcinoma therapy.

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INTRODUCTION: As cutaneous head and neck malignancies are highly prevalent especially in older patients, the risk of surgical complications is substantial in this potentially vulnerable population. The objective of this study was to evaluate the value of geriatric assessment of this population with respect to postoperative complications. METHODS: Patients were prospectively included in OncoLifeS, a databiobank. Before surgery, patients underwent a geriatric assessment including multiple validated screening tools for frailty, comorbidity, polypharmacy, nutrition, functional status, social support, cognition and psychological status. Postoperatively, complications (Clavien-Dindo ≥ grade II) were registered. Uni- and multivariable logistic regression analyses were performed yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). RESULTS: 151 patients undergoing surgery for cutaneous head and neck malignancies were included in this study (mean age 78.9 years, 73.5% male). In a multivariable analysis, frailty measured by the Geriatric 8 (G8) (OR = 6.34; 95%CI:1.73-23.25) was the strongest independent predictor of postoperative complications, among other predictors such as major treatment intensity (OR = 2.73; 95%CI:1.19-6.26) and general anesthesia (OR = 4.74; 95%CI:1.02-22.17), adjusted for age and sex. CONCLUSION: Frailty, measured by G8, is the strongest predictor of postoperative complications in patients undergoing surgery for cutaneous head and neck malignancies in addition to treatment intensity and type of anesthesia. Geriatric screening on multiple domains is recommended for patients with cutaneous malignancies undergoing head and neck surgery is recommended, as this population includes old patients and frequently suffers postoperative complications.

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INTRODUCTION: Currently, there is limited literature on reconstructive trends for inpatient head and neck skin cancer. Rather, studies have focused primarily on patients treated on an outpatient basis. To gain a better understanding of the effect that reconstructive correction of complex skin cancer defects has on the healthcare system, we examined the existing incidence and reconstructive trends of head and neck melanoma and nonmelanoma skin cancer (NMSC) in the inpatient setting. METHOD: We performed the analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database (NIS) for the years 2012-2014 of the United States (US). Adults diagnosed with melanoma skin cancer or NMSC of the head and neck region were included. Patient characteristics, reconstructive modality, surgical specifics, and outcomes were retrieved. Trends with time for reconstruction techniques were analyzed. RESULTS: In total, 41,185 patients with a diagnosis of skin malignancy were identified, of whom 5,480 (13.3%) underwent reconstruction. Most patients were white (90.0%), male (71.6%), and had a diagnosis of NMSC (79.2%). An increase in flap reconstruction (p < 0.001) was observed. After population adjustment, the highest incidence of skin malignancy was found in the Northeast. CONCLUSION: There has been a trending increase in inpatient NMSC and melanoma skin cancer of the head and neck region, correlating to an increase in the reconstructive procedures performed, and greater cost burden. Resources may be allocated toward early identification and treatment for skin cancer to help control the current rise in complex skin cancer cases necessitating inpatient admission.

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Basal cell carcinoma (BCC) is the most commonly diagnosed malignancy in humans, and as such it poses a significant healthcare burden. The majority of BCC cases are amenable to cure by surgical extirpation. However, until recently there have been no good treatment options for a significant minority of advanced BCC cases, including locally advanced BCC and metastatic BCC. The introduction of a novel class of drugs, the Hedgehog pathway inhibitors, into clinical practice has ushered in a new treatment algorithm for the treatment of difficult BCC cases. In this review we present the latest available evidence and discuss areas for further research in this rapidly evolving field.